TONGUE AND LIP TIES
Are you experiencing pain while breastfeeding, possibly combined with slow weight gain for your baby? While the vast majority of such breastfeeding problems can be resolved by adjusting positioning and attachment, and with good breastfeeding management, occasionally tongue tie might be the cause of the problem.
Tongue tie (ankyloglossia) is caused by a tight or short lingual frenulum (the membrane that anchors the tongue to the floor of the mouth). The frenulum normally thins and recedes before birth. Where this doesn’t happen, the frenulum may restrict tongue mobility. Tongue tie often runs in families and is thought to be more common in boys than girls. There is an association between high or unusual palates and tongue tie, because restricted tongue movement can affect the shape of the palate.
Breastfeeding challenges can also occur for other reasons. Identifying the cause is important when deciding on appropriate solutions, so seek help from someone skilled. Find local LLL support here.
IDENTIFYING TONGUE TIE
When your baby tries to lift their tongue or move it forwards it may appear misshapen, short or heart-shaped, with the frenulum clearly pulling its center down and restricting its movement. Or you may be able to see or feel firm tissue where the tongue meets the floor of the mouth. Degrees of tongue tie vary, and it can be difficult to diagnose accurately. A short, tight, posterior tongue tie is rarer, but may be particularly hard to spot, especially if a healthcare provider is not well-trained in identifying oral restrictions.
HOW BREASTFEEDING MAY BE AFFECTED
Tongue tie affects tongue movement to varying degrees. The shorter and tighter it is, the more likely it is to affect breastfeeding. Some babies with a tongue tie breastfeed well from the start. Others do so when positioning and attachment are improved. But any tongue tie that restricts normal tongue movement can lead to breastfeeding difficulties. A baby needs to be able to move their tongue freely and extend it over the lower gum with the mouth open wide to be able to breastfeed well. The symptoms below are all associated with poor attachment that may be caused by tongue tie.
A baby may:
- Be unable to latch on to the breast at all
- Be unable to latch on deeply, causing nipple pain and damage
- Have difficulties staying on the breast, making a clicking sound as they lose suction
- Have difficulties staying on the breast and keep slipping to a more shallow latch on the nipple only
- Splutter and choke when coping with fast flowing milk
- Breastfeed constantly to get enough milk
- Have poor weight gain or need supplementation to maintain adequate weight gain
- Develop jaundice that needs treating
- Be fussy at the breast when the milk flow slows
- Develop colic
A nursing parent may experience:
- Pain during feeds, with damaged nipples. The nipple may be compressed or distorted into a wedge shape (like a new stick of lipstick) immediately after feeding, often with a stripe at the tip of the nipple
- Engorgement, blocked ducts and mastitis because of ineffective milk removal
- Low milk production because of ineffective milk removal
- Oversupply if the baby compensates for not being able to breastfeed well by nursing very frequently
- Tiredness, frustration and discouragement
- Early weaning
TREATING TONGUE TIE
Some nursing pairs are able to compensate for a tongue or lip tie with attention to positioning and a deeper latch. Others still experience negative effects. There is evidence that treating tongue tie by frenectomy or frenotomy (see below) is effective in resolving breastfeeding difficulties. Weight gain can improve dramatically. As well as the ongoing breastfeeding benefits, continuing to breastfeed after frenectomy maximizes a baby’s chance of normal mouth (palate), speech and dental development. This includes tongue mobility for licking and moving particles of food around the mouth which helps prevent tooth decay.
What can be done?
Frenectomy—a surgery that divides the tongue tie—is also called frenotomy or tongue tie revision. It can dramatically improve breastfeeding comfort and efficiency for both mother and baby. Dividing a tongue tie is generally a quick and simple procedure.
There are health professionals including some pediatric dentists and otolaryngologists who have been specifically trained to divide tongue ties. For treatment, you may need a referral from your midwife, doctor, pediatrician, or other healthcare professional. Knowledge about tongue ties and how they affect breastfeeding varies from practitioner to practitioner, so it may be worth persisting and seeking a second opinion.
Is waiting an option?
Sometimes a very thin tongue tie breaks spontaneously or can be stretched by gentle massage of the frenulum. The earlier a tongue tie is divided, the easier it is to resolve any breastfeeding difficulties. Dividing a tongue tie in a child over six months may be a more complicated procedure and usually requires a general anesthetic.
Frenectomy—what will happen?
After the healthcare professional’s initial assessment, your baby will be swaddled and held (often by an assistant) so the baby stays still during the procedure, which only takes a minute or two. The health professional lifts the tongue and divides the frenulum by cutting it with a pair of sterile scissors or by laser.
If things don’t resolve
Often there is instant improvement in breastfeeding. Sometimes it takes a week or two for a baby to adjust to the tongue’s greater mobility. An older baby may find it harder to adjust to increased tongue mobility and tongue exercises may be recommended. Occasionally ,a baby’s frenulum needs to be revised a second time, usually because the revision was not quite extensive enough the first time. If you suspect that the initial procedure has not resolved your baby’s breastfeeding problems, arrange another consultation. Do persist with finding solutions. If several factors are involved it can take time and expertise to resolve the problem. An LLL Leader can help support you during this process.
Sore Nipples, LLL USA
Low Milk Supply, LLL USA
Positioning and Latching, LLL USA
Liz’s Story: Struggles with Tongue-Tie and Weight Gain, LLL USA blog
Katelyn’s Story: Overcoming mastitis and tongue-tie, LLL USA blog
Breastfeeding is My Superpower, LLL USA blog
My Grandmother’s Breastfeeding Legacy: Never Give Up, LLL USA blog
Rest Is Best, LLL USA blog
Overcoming Mastitis and Tongue-tie, LLL Canada blog
IS YOUR CONCERN OR QUESTION NOT COVERED HERE?
Please contact a local LLL Leader with your specific questions.
Medical questions and legal questions should be directed to appropriate health care and legal professionals.
Page updated January 2020